Pulmonary Edema
What is Pulmonary edema?
Pulmonary edema refers to an accumulation of fluid in the lungs. The air sacs of the lungs become waterlogged, making it difficult to breathe. Untreated, pulmonary edema can lead to respiratory arrest and death.
Pulmonary edema is most commonly associated with heart failure. When the left side of the heart fails to empty completely with each contraction, or has difficulty accepting blood returning from the lungs, the retained blood creates a back pressure. The lung circulation system becomes congested with blood, interfering with the fluid infiltration balance. This, in turn, leads to excess fluid build-up in the lungs.
Although typically a complication of heart failure, pulmonary edema can occur following lung and heart surgery, stroke, infection, renal failure, near-drowning, head trauma, and cocaine or heroin abuse. Pulmonary edema can also occur as a complication of improperly-performed intubation, and rapid administration of blood, plasma, serum albumin, intravenous fluids, or intravenous narcotics. Occasionally pulmonary edema is the first sign of heart disease. Many cases of pulmonary edema occur in otherwise healthy individuals exerting themselves at high altitudes to which they are unaccustomed.
How is it diagnosed?
History: Symptoms of pulmonary edema include difficulty breathing or shortness of breath, anxiety, and coughing up pink, frothy sputum.
Physical exam: Physical findings include pallor or a bluish skin coloration, engorged neck veins, rapid heartbeat, elevated blood pressure, wheezing, swelling in the hands and feet, and profuse sweating.
Tests: A chest x-ray, echocardiogram (in which ultrasound is used to detect structural or functional abnormalities of the heart), and heart catheterization (procedure in which a tiny catheter is introduced into the heart in order to diagnose and assess its condition) may aid in the diagnosis of pulmonary edema.
How is pulmonary edema treated?
Most individuals require immediate hospitalization with emergency treatment. This may include heart-regulating drugs, a fast-acting diuretic to eliminate excess body fluid, morphine to relieve anxiety and pain, bronchodilating drugs to widen airways in the lungs, and supplemental oxygen. The individual must be continuously monitored until the condition returns to normal. Post-hospitalization measures often include a low-sodium diet, regular exercise, avoiding smoking, and regular follow-up exams to monitor progress.
Medications
What might complicate it?
Untreated, pulmonary edema can lead to respiratory arrest and death. Exacerbation of any underlying heart condition or irregular heart rhythms can worsen pulmonary edema. Associated primary lung disorders (emphysema, chronic obstructive pulmonary disease) will make the treatment more complicated.
Predicted outcome
The outcome of pulmonary edema depends on the underlying cause. Non-cardiogenic (not heart related) pulmonary edema generally responds well to treatment, while cardiogenic pulmonary edema has a variable mortality rate.
Alternatives
Pulmonary edema is easily diagnosed and presents much differently from other conditions resulting in poor gas exchange. The diagnostic challenge is determining if the condition is related to heart disease (cardiogenic) or to other causes.
Appropriate specialists
Cardiologist, cardiopulmonary specialist, and internist.
Last updated 6 April 2018